Our last post addressed some of the key points for employers to share with employees during open enrollment season. One area that we mentioned was things to consider when changing insurance carriers. If it involves a change of health insurance plan it can be especially stressful for employees and/or their dependents who have ongoing medical issues. Here are some tips to help guide them through that time.
First, they need to verify that their health care providers participate with the new health insurance carrier. Most insurance plans contract with the same primary and specialty physicians. Differences are most common in the areas of mental health and substance abuse treatment providers. However, many insurance companies now offer “limited network” plans in exchange for lower premiums. Once an employee knows which plan they are joining there are a few ways to can verify if their doctor &/or hospital are “in-network”:
· Ask their doctor!!
· Call the health plans “Member Services” department.
· Go the health plan website and use their “Find a Doctor” feature. You do not need to be a member to access this feature.
If an employee or dependent is scheduled for a medical service he/she may need to have it approved by the new health plan. This can be difficult to do prior to your effective date as a “member.” If this is the case he/she should speak with their primary care or specialty doctor and let them know which health plan they are switching to. The doctor may need to write a new referral or get authorization for the treatment, and there are some circumstances where treatment will need to be rescheduled to allow time for the approval. Finally, some insurance companies offer a formal transition of care plan that can be helpful.
If an employee is currently using mail order prescriptions they will need to have those transferred to the new health plan’s mail order vendor. This process will vary depending on which health plan is involved, but at minimum a new prescription is required. The new health plan will be able to explain how to expedite the process.
Many drugs require prior approval or step therapy. If someone has already gone through the process it can be especially frustrating to be asked to start again. However in some cases that is what will happen. Again, the employee should turn to their health care provider for assistance. They know what information the health plans need to expedite approval.
Once an employee’s coverage is effective they should register for the health plan’s portal. There are many tools on the website that can make it easier for members to understand their benefits and take full advantage of their enrollment. We can address these more in our next blog post.
